Carol Declue, LMSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

075896 Issued in NY

Practice address

1400 Noyes Street
Mohawk Valley Psychiatric Center- York Street Clinic
Utica, NY 13502

Phone

(315) 738-2660

Fax

(315) 738-4410

NPI assigned

Aug 29, 2006

Last updated

Jul 13, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1871602656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3413 STATE HIGHWAY 8",
            "city": "SOUTH NEW BERLIN",
            "state": "NY",
            "postal_code": "138432120",
            "telephone_number": "607-859-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 NOYES STREET",
            "address_2": "MOHAWK VALLEY PSYCHIATRIC CENTER- YORK STREET CLINIC",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "13502",
            "telephone_number": "315-738-2660",
            "fax_number": "315-738-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECLUE",
        "first_name": "CAROL",
        "name_prefix": "Ms.",
        "credential": "LMSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "067256",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "075896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP MOHAWK VALLEY PLAN",
            "identifier": "713667",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Marie Decarolis, REGISTERED NURSE
• Alexa Rae Decarr
• Kayla Decarr, LCSW
• Brian Decker, LMHC
• Sarah Decker, CASAC
• Rebecca A Deeley, M.D.
• Kristen M. Deep, FNP
• Deerfield Family Practice, PLLC
• Lisa Deering
• Alison C Defrank

• Clinical Social Worker in Utica, NY
• Providers in Utica, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.